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Press releases Saturday 17 December 2005

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(1) Boys more likely when pregnancy takes longer

(2) NHS failing to provide health care according to need

(3) Denying joint replacements based on prejudice ± and is false economy

(4) EU and G8 countries must help Russia tackle its health crisis

(1) Boys more likely when pregnancy takes longer
(Time to pregnancy and sex of offspring: cohort study)
http://bmj.com/cgi/content/full/331/7530/1437

The longer it takes to get pregnant, the more chance there is of having a boy, finds a study in this week±s BMJ.

Dutch researchers analysed data for 5,283 women who gave birth to single babies between July 2001 and July 2003.

Among the 498 women who took longer than 12 months to get pregnant, the probability of male offspring was nearly 58%, whereas the proportion of male births among the 4,785 women with shorter times to pregnancy was 51%.

The authors calculate that, for couples conceiving naturally, each additional year of trying to get pregnant is associated with a nearly 4% higher expected probability of delivering a male baby, even after adjusting for factors such as age, smoking status, alcohol use, and variability of the menstrual cycle.

In contrast, sex of the offspring of couples who had received medical help in getting pregnant did not show any relation with time to pregnancy.

These findings support the idea that, in viscous fluids, sperms bearing the Y (male) chromosome swim faster than those bearing the X (female) chromosome, say the authors. Women whose cervical mucus is relatively viscous would not only have more difficulties conceiving naturally, but also have a higher probability of male offspring if they do get pregnant.

Furthermore, the findings may explain why, throughout the world, more boys than girls are born (105 boys to 100 girls in most countries), despite the fact that human semen holds equal amounts of X bearing and Y bearing sperms.

Contact:
Luc Smits, Lecturer, Maastricht University, Department of Epidemiology, Maastricht, Netherlands Email: luc.smits@epid.unimaas.nl

(2) NHS failing to provide health care according to need
(Deprivation and volunteering by general practices: cross sectional analysis of a national primary care system)
http://bmj.com/cgi/content/full/331/7530/1449

The NHS needs to do more to provide health care according to need, argue researchers in this week±s BMJ.

They analysed the availability of primary care according to deprivation and health need in Scotland. Their study was based on a sample population of 5.35 million people served by 1,050 general practices and divided into ten groups of equal size according to deprivation.

They show that ill health is two and a half times greater in the most deprived group compared to the most affluent, but the number of whole time equivalent GP principals is distributed evenly across the population.

However, including non-principals and doctors in training, there are 11% more GPs in the more affluent compared with the more deprived half of the population.

Although they found larger numbers of practices in the most rural and deprived areas, this reflects the higher proportion of single handed and small practices in such areas, say the authors.

In fact, they show that practices in deprived areas tend to have younger doctors, fewer female doctors, and less involvement in voluntary activities such as quality schemes, health service initiatives, and training than practices serving more affluent areas.

Practices serving the most deprived areas are less likely to volunteer because they are so consumed by dealing with increased levels of morbidity, without increased levels of medical manpower, that they are unable or unwilling to take on additional activities, they write.

Professor Graham Watt, from the Department of General Practice at Glasgow University commented: ±Our paper helps to explain the persistence of health inequalities in the UK, and the under-achievement of the NHS in narrowing these inequalities.

The strict rationing of medical manpower, irrespective of need, places a major constraint on what the NHS can deliver in deprived areas. It follows that general practitioners in such areas have to ration what they do for patients in the time available.

Too many NHS agencies have policies and initiatives which fizzle out in the most deprived third of the population. There is an urgent need for NHS initiatives and support systems which reach the parts that current approaches fail to reach,± he concludes.

Contact:
Graham Watt, Professor of General Practice, University of Glasgow, Scotland, UK Email: gcmw1j@clinmed.gla.ac.uk

(3) Denying joint replacements based on prejudice ... and is false economy
(Letters: Rationing joint replacements)
http://bmj.com/cgi/content/full/331/7530/1472

A decision by NHS trusts in Suffolk to deny replacement joints to obese patients seems to be based on prejudice or attribution of blame, argues a senior doctor in a letter to this week's BMJ.

In fact, no evidence supports withholding joint replacement from obese people, even on utilitarian grounds, says Nicholas Finer, a consultant in obesity medicine at Addenbrooke±s Hospital, Cambridge.

For knee replacement, there is ±no evidence that age, gender, or obesity is a strong predictor of functional outcomes,± while a UK health technology assessment of hip replacement concluded that obese patients could benefit from surgery and are not noticeably at increased operative risk.

Another study concluded that relative body weight alone does not influence the benefit derived from hip replacement surgery, he writes.

±Since obesity does not increase the risks or diminish the benefits of joint replacement, the trust±s decision to deny such treatment seems to be based on prejudice or attribution of fault, or both,± he says. ±Logically extended, such a policy would deny treatment to, among others, smokers, most patients with HIV infection, and those who sustain sports injury.±

Rationing joint replacements is also false economy and potentially damaging, writes retired doctor, Martin McNicol in another letter.

Delaying operations on ±punitive± grounds may increase long term costs. Personal experience shows that delaying joint replacement surgery causes deterioration of functional capacity, which is difficult or impossible to reverse after later operation. ±This is rationing by any other name,± he says.

Contacts:
Nicholas Finer, consultant in obesity medicine, Addenbrooke±s Hospital, Cambridge, UK. Email: nf237@medschl.cam.ac.uk
Martin McNicol, retired, Cirencester, Gloucestershire, UK Email: mcnicol@globalnet.co.uk


(4) EU and G8 countries must help Russia tackle its health crisis
(Editorial: The health crisis in Russia)
http://bmj.com/cgi/content/full/331/7530/1418

Countries in the EU and G8 must help Russia tackle its health crisis, says an editorial in this week±s BMJ.

Russia is one of the few developed countries where life expectancy has fallen in recent years, writes Rifat Atun of Imperial College London. Russia±s total life expectancy of 66 years lags behind that of Japan by 16 years, the European Union by 14 years, and the United States by 12 years.

High levels of death and illness from non-communicable diseases, along with a low birth rate, mean that Russia±s population is rapidly becoming smaller and sicker. This could lead to an economic burden that Russia may not be able to afford, given that its gross domestic product (GDP) is the lowest of all the G8 countries, he warns.

For EU and G8 leaders, a stable, healthy, and economically strong Russia is strategically important. In 2006 Russia will assume the rotating presidency of the G8. President Vladimir Putin has an opportunity to lead the global health debate and keep health high on the G8 agenda.

But first Russia must kick start the transformation of its own health system. And G8 and EU leaders must assist in driving through the health reforms it most desperately needs, he concludes.

Contact:
Rifat Atun, Director, Centre for Health Management, Tanaka Business School, Imperial College, London, UK Email: r.atun@imperial.ac.uk

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